Outline

Objective: The aim of this study is to evaluate the outcome of percutaneous endoscopic lumbar discectomy (PELD) in terms of postoperative pain in the first 6 months after surgery.

Methods: Between September 2004 and April 2010, 240 percutaneous endoscopic disc herniation surgeries have been carried out, 21 of them had intra-and extraforaminal disc herniation at level L5/S1. PELD has been performed in 11 males and 10 females. All operations performed by a single surgeon with the YESS system (Wolf) or a new designed prototype from Storz. Appropriate conservative therapies were done in all patients before surgery. The clinical findings and MRI were the main diagnostic methods. Preoperative evaluation was performed with clinical examinations, visual analogue pain scale (VAS) and Oswestry Low Back Disability index (ODI). Postoperative evaluations were performed at 2 days, 3 weeks and 6 months after surgery. Intraoperative epidural block was performed in 71% of the cases.

Results: Out of 21 patients there were 7 patients with extraforaminal, 13 extra-and intraforaminal and one intraforaminal disc herniation. The mean age of the patients was 53,6 years; the mean preoperative duration of the pain was 11,3 months. The mean operative time was 46,5 minutes and the mean intraoperative X-ray duration was 2,3 minutes. The mean preoperative ODI was 69.1 (Â±19) and 26.5 (Â±24.3) postoperatively; the mean change between pre and post was 42.7 (Â±27.6), p-value 0.001. Preoperative VAS was 88.3 (Â±7.9) and 26.4 (Â±23.7) at 2 days, 38.1 (Â±23.0) at 3 weeks and 33.6 (Â±6.2) at 6 months postoperative. The paired sample t-test showed a high significant in all compared groups except in VAS at 3 weeks and 6 months. The incidence of postoperative leg pain and back pain was 14.2%. Neuropathic pain was recorded in 6 patients, 3 of them have been treated with Pregebalin and Fortecortin successfully. Revision surgery was recommended in 2 patients due to persistent leg pain, one had an open microdiscectomy and in the second patient an instrumented spinal stabilisation was performed.

Conclusions: The PELD is an effective treatment method of intra-and extraforaminal disc herniation at level L5/S1, avoiding the disadvantages of the standard surgical procedures with a lower incidence of neuropathic pain.